374600890-5-26-2023-08-AS-SJAB-CSCTPL-20230531145428

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 05/25/2023
Date Signed: 05/26/2023 01:24:53 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/19/2023 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20230519100835

FACILITY NAME:	ATRIA COLLWOOD		FACILITY NUMBER:	374600890
ADMINISTRATOR:	ARTEAGA, IRMA		FACILITY TYPE:	740
ADDRESS:	5308 MONROE AVE		TELEPHONE:	(619) 286-3583
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	185	CENSUS: 85	DATE:	05/25/2023
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Executive Director Julia Lopez		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Staff did not ensure that resident records and personal information remains confidential.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to commence and conclude a complaint investigation. LPA was granted entry after identifying herself. LPA discussed the purpose of the visit and the basic elements of the allegation mentioned above with Executive Director (ED) Lopez.

The Department's investigation included a review of residents records and a resident interview and LPA observation.

It was alleged staff did not ensure resident records and personal information remained confidential. An interview with an Outside Source (OS1), revealed Resident1(R1) was given another Resident's documents containing confidential information. LPA conducted a record review that confirmed the violation occurred.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 08-AS-20230519100835

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ATRIA COLLWOOD	FACILITY NUMBER: 374600890
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/25/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/28/2023 Section Cited CCR 87506(c)(1)	1 2 3 4 5 6 7	(c) All information and records obtained ... regarding residents shall be confidential.(1) The licensee shall be responsible for....safeguarding the confidentiality of their contents....all employees shall reveal...confidential information only upon the resident's written consent or... designated representative. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	ED Lopez decided will hold an in-service with care and med-tech staff on personal rights regarding resident confidentiality and safegaurding confidential information/documents.
	8 9 10 11 12 13 14	Based in LPA's interview, observation, and records reviews staff did not safegaurd confidential records for 1 out of 85 residents in care. This posed a potential personal rights violation for residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20230519100835

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ATRIA COLLWOOD	FACILITY NUMBER: 374600890
	VISIT DATE: 05/25/2023

NARRATIVE

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Based on LPA's interview, observation, and a facility records review, the above allegation is substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met.

LPA Correia conducted an exit interview with ED Lopez. At the time of the exit interview Ed Lopez was given a copy of the Complaint Investigation Reports (LIC9099 and LIC 9099D) and Licensee Rights (LIC9058 01-2016) and signature on this report acknowledges receipt of the documents.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC9099 (FAS) - (06/04)

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